Erector Spinae Plane (ESP) block and Paravertebral Block (PVB): Key Differences

The Erector Spinae Plane (ESP) block and Paravertebral Block (PVB) are both regional anesthesia techniques used for pain management, but they have some key differences in terms of anatomy, technique, and clinical applications

Anatomy and Injection Site

ESP Block: The local anesthetic is injected into the fascial plane between the erector spinae muscle and the transverse processes of the vertebrae. This allows the anesthetic to spread cranially and caudally, affecting multiple spinal nerves [1].

PVB: The local anesthetic is injected into the paravertebral space, which is bordered by the vertebral bodies, intervertebral discs, parietal pleura, and superior costotransverse ligament. This space contains the spinal nerves, sympathetic chain, and intercostal vessels [2].

Ultrasound Guidance

ESP Block: Ultrasound guidance is used to visualize the erector spinae muscle and transverse processes, ensuring accurate needle placement and spread of the anesthetic [1].

PVB: Ultrasound guidance is also used for PVB to visualize the paravertebral space and ensure precise needle placement, reducing the risk of complications such as pneumothorax [2].

Spread of Anesthetic

ESP Block: The anesthetic spreads in the fascial plane, potentially affecting multiple levels of spinal nerves and providing broad analgesia [1].

PVB: The anesthetic spreads within the paravertebral space, providing segmental analgesia by blocking the spinal nerves at specific levels [2].

Clinical Applications

ESP Block: ESP blocks are versatile and can be used for thoracic, abdominal, and even some lower limb surgeries. They are particularly useful in multimodal analgesia regimens and enhanced recovery after surgery (ERAS) protocols [1].

PVB: PVBs are commonly used for thoracic surgeries, including breast surgery, and provide effective unilateral analgesia with minimal hemodynamic effects [2].

Safety and Complications

ESP Block: The ESP block is considered easier to perform and has a favorable safety profile. Complications are rare but can include pneumothorax and local anesthetic systemic toxicity [1].

PVB: PVB has a slightly higher risk of complications, such as pneumothorax and vascular puncture, but the use of ultrasound guidance has significantly reduced these risks [2].

Training and Proficiency

ESP Block: Requires training in ultrasound-guided techniques but is generally considered easier to learn and perform compared to PVB [1].

PVB: Also requires proficiency in ultrasound-guided techniques and is considered more technically challenging due to the deeper and more complex anatomy [2].

Summary

While both ESP and PVB blocks are effective for regional anesthesia, the ESP block is often preferred for its ease of use and broad analgesic coverage, whereas the PVB provides more targeted segmental analgesia and is traditionally used for thoracic surgeries.

Paravertebral Block (PVB) and the Erector Spinae Plane (ESP) Block comparison table